Father's Name *

First Name

Last Name

Father's Cell Phone *

(###)

###

####

Mother's Name *

First Name

Last Name

Mother's Cell Phone *

(###)

###

####

Family Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child lives with *

First Name

Last Name

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

#1 Child's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Completed Sacraments: *

Choose all that apply

Baptism

Eucharist

Penance

Sacramental Prep Needed

#2 Child's Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Completed Sacraments:

Choose all that apply

Baptism

Eucharist

Penance

Sacramental Prep Needed

#3 Child's Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Completed Sacraments:

Choose all that apply

Baptism

Eucharist

Penance

Sacramental Prep Needed

#4 Child's Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Completed Sacraments:

Choose all that apply

Baptism

Eucharist

Penance

Sacramental Prep Needed

#5 Child's Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Completed Sacraments:

Choose all that apply

Baptism

Eucharist

Penance

Sacramental Prep Needed

I agree to supply St. Pius X with a copy of my 2nd Grader or 11th Grader's Baptism Certificate if I have not already done so. *

I will supply my child's Baptism Certificate

I have already supplied my child's Baptism Certificate

6th-12th Grade Child's Name

First Name

Last Name

6th-12th Grade Child's Cell Phone

By listing your child's phone number, you give permission to enter into flocknote messaing system. Your child will receive text about youth events.

(###)

###

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Participation Waiver

As a parent/guardian of the child(ren) listed on this form, permission is hereby given for my child(ren) to participate in activities sponsored by St. Pius X. I recognize that engaging in the activities at St. Pius X may expose my child (ren) to the possibility of physical injury and agree to hold St. Pius X Catholic Church harmless, as well as their employees, organizers, and any volunteers assisting in the programs, from liability and claims arising out of my child's participation in programs subsidiaries, and related activities.

I agree

I do not agree

Photograph Waiver

As part of the education programs, pictures are occasionally taken of the students participating in activities and events. Please, indicate below whether St. Pius X may include pictures of your child(ren) in our parish bulletin or on the parish website/social media. WE WILL NOT IDENTIFY YOUR CHILD(REN) BY NAME.

I agree

I do not agree